Dr. William Rassman – Page 1840

March 22, 2006

Removing a Sebaceous Cyst from the Eyebrow – Balding Blog

Hi. My 9-year-old daughter has what the plastic surgeon called a ’sebaceous cyst’ on her left eyebrow (actually sort of in her eyebrow). It started out very small about six months ago and has become so large it distorts her eyebrow hair. He is supposed to remove it on April 5. My question is that she is terribly afraid of scarring: the doc said it won’t happen bc he’ll excise it directly in the eyebrow line. Do all of these cysts HAVE to be removed surgically? Is there any other way to remove them?
Thanks!

When I was in residency training I saw a middle aged bus driver who had a sebaceous cyst on her buttock. It bothered her while she worked, sitting on her bus driver seat. I apologize if this is too graphic, but she finally came to see me when it was the size of a big orange with a foul smelling infection on top of it. When I asked her why she waited so long, she said she didn’t want surgery so she prayed for it to go away.

My point is, sebaceous cysts have the tendency to become infected and when they do, it does create a minor surgical problem, so the issue is: should they be removed? It might be in your daugther’s interest because the alternative will be, as you put it, a “distorted eyebrow” which could become a focus issues for her in her teenage years. All surgical procedures have risks. All surgical procedures will leave a scar and the eyebrow in particular may lose eyebrow hair that will not grow back. But as you have been informed by the plastic surgeon, he/she should take great care to leave a minimal scar in the most inconscpicuous place (along the eyebrow line to hide the scar).

March 21, 2006

Hair Loss InformationAngry and Depressed Strip Surgery Patient – Hair Loss Information – Balding Blog

Dear Dr William!!!
I have to say that I’m very sorry doing FUSS on my 6-7 scale bald head. It does not give me chance to cut my hair short and the stripe is from one ear to another, very ugly. Doing a stripe more than 10cm should be forbidden. When I came for surgery i thought “if something went wrong i’m gonna shave”. Dont you think that is better to have a procedure with less FUE and be able to cut hair short, to make a nice hair line. if the vertex is bald it doesnt look bad when the hair is short. I’m sorry I realized that after my surgery. Cant you people see how many people suffer from this frankenstein scar? it is a sin to cut somebody like that. Besides that all the pictures lie about fullness of hair and also nobody ever mentions that the hair above and under the scar can have a big difference in fullness which looks very ugly.

I’m a very depressed and mentally destroyed 33 year old man. I had one chance for HT and I lost it with one of the greatest doctors that could not evaluate me and give me right advice . I signed all these scary papers just because I was trusting him, after all this I see it was all about the money. I would give now everything I have just to go back to normal. Please start up with some medical law to stop doing FUSS. The papers I signed are too scary to be offered to humans.

Unfortunately I will have to wear a hat in public for the rest of my life, probably at home too because I dont want my poor mother looking at me like this. People have done the HT for last 40 to 50 years and still do not realize that strip is wrong technique. To sign so many scary papers, like for FUSS, means that doctor still doesnt know what he is doing. I’m sure it is about the time when FUSS will be forbidden. God bless

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First, it must be pointed out that this man is not one of my patients.

I sympathize with your predicament and I’m sorry for your situation. The truth is, though, that there are many patients for whom a scar is much less of an issue than the alternative of having a Norwood Class 6 or 7 bald head. For those readers who are unfamiliar, there are some doctors that refer to the Follicular Unit Transplantation (strip procedure) as “FUSS” (Follicular Unit Strip Surgery). I don’t know what your scar looks like, and the fact that it bothers you so much means that it is unacceptable to you, yet these are issues that one needs to deal with before the surgery.

A few points that I want to highlight:

The hair transplant procedure happens on your head, so you must think about every option and its possible consequences carefully.
Never, ever sign anything that you do not understand. If you thought “these scary papers” were too much for you, you should’ve taken a step back and perhaps re-evaluated what you were doing before you agreed to it! This goes for anything you sign your name to. No matter how “trusting” you are, there is no excuse for signing any contract or papers without knowing what you are signing. What you most likely signed was an Informed Consent. According to the American Medical Association:
Informed consent is more than simply getting a patient to sign a written consent form to protect the doctor when something goes wrong. It is a contract between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical or surgical intervention. In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with you:
- The diagnosis, if known;
- The nature and purpose of a proposed treatment or procedure;
- The risks and benefits of a proposed treatment or procedure;
- Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
- The risks and benefits of the alternative treatment or procedure; and
- The risks and benefits of not receiving or undergoing a treatment or procedure.
How could you call the doctor who did your surgery “one of the greatest doctors” if he never gave you the “right advice” and you are so dissatisfied with the surgery? You should go back to your doctor to discuss your concerns.
All surgical procedures will leave a scar. Most hair transplant scars can be easily covered by your hair, even with a short haircut. Note that if you shave your head, it will show. I had two hair transplants, and rarely can anyone find my scar unless they work my hair with a comb and use a very bright light, but if I shaved my head (something I do not ever plan to do) one would see a ‘smile’ on the back of my head reflecting this scar, though again, it would be very hard to find when I have hair grown to any length. Finally, if your scar is more than 5mm thick, you may have a keloid formation or may be a candidate for a scar revision (a type of fix that good doctors can do). All of this should have been covered in your Informed Consent.
You state that you are “very depressed and mentally destroyed” and just want to go back before the transplant was done. You condemn your doctor who you have suggested just showed you pictures that lied about the fullness you were going to get. We have open house events in my practice to allow prospective patients to meet actual patients. I do agree that pictures are often not adequate, because they show you what the photographer wants you to see, but by meeting patients, it gives you a good chance to see the quality that you are going to get. As the expression goes, hindsight is 20/20, and hopefully knowing what you know now, you would’ve asked to meet patients in person. This should also be an important lesson for the readers considering a hair transplant (or any cosmetic procedure, really).
Depression is a serious matter and you should think that about getting help directed to what is inside your head, not just addressing the subject of hair loss or scarring. Every human being would love to undo some decisions in their lives, but that is just not reality. As I’ve mentioned on this blog before, I always tell people that the good news and the bad news about hair transplants is that they are permanent. Going back in time is therefore not an option.

I have compassion for you, but you must take charge of your own situation by doing something positive about it. If you can make it to the Los Angeles area and would like me to judge what you have going on, come visit me or send me a good set of photos. At least that would be a small ‘baby step’ in the right direction by starting to take charge of your problem the correct way.

March 21, 2006

Propecia for Hairline – Hair Loss Information – Balding Blog

Hello again doc, I’ve taken your advice on taking procepia instead of saw palmeeto pills. I still have a patchy thinning hairline that’s type I on the right side and type II on the left side. My question is, how long will it take until my hairline thickens and returns to type I on both sides? My dermatologist prescribed Proscar for a period of one year.

And one more question, my mom is in her late 40’s and has been thinning and receding around the front as well, though her’s is more apparant. Is there anything you can recommend for her? Thanks.

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These drugs will probably not reverse the frontal hair loss. It will be more preventive for future hair loss if the cause is genetic. If you are talking about Norwood Class 1 to a Norwood Class 2, then this could be just a maturing hairline and I do not frankly know if Propecia /Proscar will stop the hairline from evolving naturally. My question for you is: How do you know that you have genetic hair loss? You need to have your hair mapped out for miniaturization to determine if you have hair loss.

Wiht regard to your mother, female hair loss has been extensively covered in previous blog entries and I refer these to you and to her.

March 21, 2006

Avodart vs Propecia – Hair Loss Information by Dr. William Rassman

Is there any evidence that avodart is more effective than propecia?

During the 2005 International Society of Hair Restoration Surgery (ISHRS) conference in Australia, there were some suggestions that Avodart may be more effective than Propecia. However, the FDA has not approved Avodart for treating male pattern baldness, most likely because the drug company has no interest in this particular market. FDA studies are driven by the profit motive of the company, and the company (which I believe started and then stopped the appropriate studies) indicated no intent to pursue this market. Nobody can not make any proofs on the effectiveness of Avodart, and therein lay the crux of the problem. Some doctors seem willing to write prescriptions for this ‘off label’ use of the drug depending upon the safety issues defined by the drug company for Prostate use.

March 21, 2006

Hair Loss with Bald Spot Above Ear – Hair Loss Information by Dr. William Rassman

This is a follow-up to Hair Loss from Propecia:

Well i also moved a couple of months before this happened. Also about two months before i moved, i dyed my hair. So im wondering if this could be telogen effluvium? Ive dyed my hair alot in my lifetime and it has seemed to make it thinner but never any hairloss of the front. And if it did it grew back and I just didnt pay my hairline much atttention back then. My Mom’s dad was bald. But thats about it. My dad has a receding hairline but he is 57, and he still has plenty of hair and i dont think he will ever go complety bald. No one else in my family is bald. I also have an almost bald spot on the side of the right ear and my hair is thinner on the sides and the top than the back. I have no good hair doctor in my area so please help.

Please send me photographs. With a bald spot now above your ear, it is possible that you have other causes for your hair loss, rather than pure genetic causes with MPB. Singular bald spots may indicate a series of other etiologies, including infectious or autoimmune causes. Any good dermatologist can address this and even with pictures, there is no substitute for a direct examination by a doctor. Dermatologist are all over the US. See the American Academy of Dermatology to find a dermatologist in your area.

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March 21, 2006

High Protein Diet Can Accelerate Hair Loss? – Hair Loss Information by Dr. William Rassman

Is it true that weight lifting and a diet high in protein can cause or accelerate hairloss?

Many weight lifters take exogenous steroids and testosterone, which increases the circulating DHT, which then produces more hair loss. The element that runs through my mind is with all of the muscle mass, does the testosterone rise? If so, the hair will fall out more rapidly in those with a predisposition to genetic balding. If the weight lifters have more stress than the typical man, then more hair loss may be present, again in those with genetic predispositions for genetic balding. There are many weight lifters that have a full head of hair, but that may be good genes.

With regard to your questions on diet, any good diet (even high in proteins) provided that it contains the daily requirement of nutrients, will not accelerate hair loss.

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March 21, 2006

Pantogar – Balding Blog

Dear Doctor Rassman,
I have been on propecia for one year. I want to ask you if I can take pantogar tablets (which is a supplement for hair loss and gray hair) along with propecia? Or will there be any negative interaction between them? Thank you vry much for your answer in advance.
Sincerely,

Pantogar capsules contain: Thiamini nitras 60 mg, Calcii pantothenas 60 mg, Cystinum 20 mg, Faex medicinalis 100 mg,Acidum paraminobenzoicum 20 mg, Keratinum 20 mg

I do not know about Pantogar, except for one article I found that seems somewhat credible: EHRS

As I have no first hand knowledge of it, I can not comment on any overlap with Propecia.

March 21, 2006

Regenix’s Patent – Hair Loss Information by Dr. William Rassman

Dr Rassman,
I did a quick search on regenix and was able to find this patent filing.

US Patent

Can you please comment on the patent. Also, would using 2.5% benozyl peroxide achieve the same goal as their chlorine dioxide and special acidic solution?

Thank you.

I am not a Patent Attorney. It is my understand that a “METHOD” patent can not be enforced for ‘market control’ because any medical process that benefits mankind can not be restricted through a U.S. Patent (1993 Supreme Court Ruling). Regenix has been on the market for about 8 years and has developed a large following. The claims by the company seem to have some scientific backing, so unlike many of the potions and lotions on the market, there may be value here. Quantifying the value is a problem for me, so I tend to keep my recommendations to the more standard FDA approved drugs like Propecia and Minoxidil.

For what it’s worth, a patent does not necessarily give credibility to a product. The U.S. Patent Office has thousands of goofy and absurd patents. One does not need to have a U.S. Patent to market anything successfully, but with government agencies that require ‘Truth in Advertising’ over the airwaves, there is a burden on marketers to keep to some standards. Unfortunately, the government does not budget for enforcement the way they should, so there are many scams out there and many do focus upon the unfortunate people with hair loss. As I have said many times on this blog, May the Buyer Beware!

I have no experience with any value with regard to 2.5% benozyl peroxide for hair regrowth. This medications works wonders for pimples, but hair is not a variant of a pimple. Acidic compounds that cause minor burns to the skin have been used for years as an antiaging skin application. Retin-A is such a similar compound for burning the skin and making it ‘tighter’. None of these medications work for reversing the aging that balding brings on.

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March 21, 2006

Transplant Risks, Stopping Propecia After Hair Transplantation – Hair Loss Information by Dr. William Rassman

What are the risks of hair transplantation?

Will I keep balding after a hair transplant?

Can I stop my hair loss with Propecia?

I am 35 years old and a Class NW 3V, will I get very bald (like a Class 7)?

A Doctor told me that I needed 3500 grafts, Is this a reasonable goal for a NW 3V?

Hair transplantation is a surgical procedure and entails all of the risks of an outpatient procedure. The risks of death and severe complications (in good hands) should approach zero. The usual risks such as infection, drug side effect/overdoses, and the like are rare. Scarring risks for strip surgery are about 5% for a scar measuring greater than 3mm. Folliculitis (local infection/cycts of hair follicles) is not an uncommon problem in the post operative course over the first few months as the sebum builds under the skin and can not get out (this is easy to treat). Most people do not have much of a problem with things that go wrong from the surgery. The biggest problem is for the patient to match his/her expectations with what the surgeon can deliver. Miscommunication here is the biggest problem of all because either patient or doctor often oversell the results.
Male patterned genetic hair loss is a life long process, but most people stabilize or slow down the progression by the time they are 35. From that time forward, hair loss is usually slower. This is what a good doctor will cover as he develops a Master Plan for your hair loss with you.
If you take Propecia (for men only), then hopefully if your goals are achieved with the drug alone, surgery may not be necessary. If Propecia alone does not solve your problem (typical for the NW 3V or more advanced balding patterns), then transplants may be necessary to achieve your goals. Again, that is where the Master Plan is customized to your needs.
A Class 3V varies in size and degree. The ability to supply enough hair from the front and crown depends upon your densities, scalp laxity, hair characteristics, shaft thickness ,and color/contrast of hair to skin. Each person is different so the actual answer to your question is that each person is different and what is good for one person may not be food for another.
It is not unusual for me to perform a session of 3500 grafts, but that depends upon what is safe and what is in the best interest of the patient according to his Master Plan. If you are 25, I would probably not consider the crown transplant. If you were 45 with good density and scalp laxity, then this may be a reasonable option depending on other factors that would be defined in an extensive consultation.

March 20, 2006

Female Hair Loss After Face Lift – Hair Loss Information – Balding Blog

I had a facelift last Sept and in Feb I noticed my hair has thinned to the balding stage. Is this permanent, caused by the facelift, or just temporary? What can I do to stimulate hair growth?

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Hair loss around the scar after a face lift surgery is a common problem. Fortunately, it is one of the indications where a hair transplant procedure will help very nicely. You should first followup with your plastic surgeon for his opinion on the permanence of the hair loss, but as this has been a year already, I suspect that it may be permanent. If you are on the west coast, please consider paying me a visit in Los Angeles or San Jose, or if you can not easily drop by, send me good photographs and I will give you an opinion. Your privacy will be protected and I will not show them here on the web without your consent.